Evaluating the Need for Increased Culturally Centric Graduate Medical Education Training Opportunities within American Indian/Alaska Native Communities

Objectives: Studies have shown that American Indian/Alaska Native (AI/AN) populations experience lower health status and poorer outcomes when compared to other Americans. Indian Health Services and Tribal Healthcare Facilities provide healthcare to approximately 2.6 million AI/AN people but are chronically facing high physician vacancy rates. Participation by healthcare facilities in graduate medical education (GME) has been demonstrated as an effective strategy to address physician workforce shortages. The availability of the Accreditation Council for Graduate Medical Education (ACGME) training programs within AI/AN communities has not been investigated. This paper will assess the number of ACGME accredited residency positions in family medicine, obstetrics and gynecology, emergency medicine, and psychiatry in the ten states with the highest population of AI/AN citizens. Additionally, we will explore the percentage of a state's total ACGME family medicine, obstetrics and gynecology, emergency medicine, and psychiatry positions that offer culturally centric training within IHS or tribal healthcare facilities.

Methods: Based on the 2019 AI/AN minority population profiles on the Human Services Office of Minority Health website, we focused our efforts on the ten states shown to have the largest Native populations: Arizona, California, Oklahoma, New Mexico, Texas, North Carolina, Alaska, Washington, South Dakota, and New York. Utilizing the ACGME Program Search website we determined the total number of ACGME accredited family medicine, obstetrics and gynecology, emergency medicine, and psychiatry positions located in each of the ten states. The ACGME Program Search website, as well as specific program websites, provided information we used to compare the total number of family medicine, emergency medicine, obstetrics and gynecology, and psychiatry positions available in each state to the number of positions within those specialties that provided focused AI/AN culturally centric training; defined as completing at least 1 month of clinical training or a longitudinal continuity clinic experience within an IHS or tribal clinic.

Results: Compared to the total number of ACGME accredited family medicine, obstetrics and gynecology, emergency medicine, and psychiatry positions the amount of culturally centric ACGME accredited positions in these specialties was found to be: 13.4% (78/581) in Arizona; 0% (0/4242) California; 31.6% (175/553) Oklahoma; (66/238) New Mexico; 0% (0/2351) Texas;0.03% (42/1244) North Carolina; 100% (36/36) Alaska; 0.07% (48/734) Washington; 0% (0/83) South Dakota; and 0% (0/2895) New York. Alaska was the state with the highest percentage of culturally centric training opportunities.

Conclusions: Our study suggests that in comparison to the total number of ACGME accredited family medicine, obstetrics and gynecology, emergency medicine, and psychiatry opportunities available, there is a significantly lower amount of ACGME accredited training opportunities in these specialties that are culturally centric to Native communities where the population of AI/AN is highest in the United States. Our findings provide evidence that showcases the need for an increase in GME training opportunities within IHS facilities or tribal healthcare clinics to potentially combat the shortage of physicians within Native Communities.